Pulitano Carlo, Joseph David, Sandroussi Charbel, Verran Deborah, Strasser Simone I, Shackel Nicholas A, McCaughan Geoffrey W, Crawford Michael
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia; Centenary Research Institute, University of Sydney, Sydney, Australia.
Liver Transpl. 2015 Feb;21(2):162-8. doi: 10.1002/lt.24043.
Hepatic artery stenosis (HAS) is thought to predispose patients to biliary complications secondary to ischemic injury. Despite this, the clinical significance of HAS remains poorly defined. The aims of this study were to determine the prevalence and outcomes of HAS and to define which patients might benefit from endovascular treatment. From a prospective database of 662 adult patients undergoing liver transplantation between 2000 and 2011, we identified 54 patients who developed HAS. HAS was defined as any stenosis > 70% that was seen during multidetector computed tomographic angiography (MDCTA) or digital subtraction angiography. The benefit of endovascular therapy was evaluated with propensity score matching. New biliary complications occurred in 17 patients (31.4%), and 23 of the 54 study patients with HAS received endovascular treatment. Among the propensity score-matched patients, the biliary stricture-free survival time was significantly longer for those who received endovascular therapy (P = 0.03). An incidental diagnosis (P = 0.07) and a time from transplantation > 6 months (P = 0.021) were associated with a reduced risk of developing biliary stricture. Patients with symptomatic HAS who received treatment had better biliary stricture-free survival than patients who were treated conservatively, although no significant difference was recorded (P = 0.11). No patient with asymptomatic HAS and normal liver function tests developed biliary strictures. In conclusion, HAS intervention was associated with improved biliary stricture-free survival. In patients with late-onset HAS (≥6 months) and asymptomatic patients, endovascular treatment is not warranted.
肝动脉狭窄（HAS）被认为会使患者易发生继发于缺血性损伤的胆道并发症。尽管如此，HAS的临床意义仍未明确界定。本研究的目的是确定HAS的发生率和预后，并确定哪些患者可能从血管内治疗中获益。从2000年至2011年期间接受肝移植的662例成年患者的前瞻性数据库中，我们识别出54例发生HAS的患者。HAS被定义为在多排螺旋计算机断层血管造影（MDCTA）或数字减影血管造影中发现的任何狭窄>70%。采用倾向评分匹配法评估血管内治疗的益处。17例患者（31.4%）出现新的胆道并发症，54例HAS研究患者中有23例接受了血管内治疗。在倾向评分匹配的患者中，接受血管内治疗的患者无胆道狭窄生存时间显著更长（P = 0.03）。偶然诊断（P = 0.07）和移植后时间>6个月（P = 0.021）与发生胆道狭窄的风险降低相关。有症状的HAS患者接受治疗后的无胆道狭窄生存率高于保守治疗的患者，尽管未记录到显著差异（P = 0.11）。无症状HAS且肝功能检查正常的患者均未发生胆道狭窄。总之，HAS干预与改善无胆道狭窄生存相关。对于迟发性HAS（≥6个月）患者和无症状患者，不建议进行血管内治疗。
